ETUDE RADIOLOGIQUE DE LA HAUTEUR ROTULIENNE DANS LA MALADIE D'OSGOOD-SCHLATTER

ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Diurnal changes in postural control in normal children: Computerized static and dynamic assessments

International audienc

Esophageal perforation caused by a thoracic pedicle screw

International audienceThis grand round raises the risk of a rare complication that can be avoided with the knowledge of the particular anatomy of scoliosis vertebra. Transpedicular screws have been reported to enhance the operative correction in scoliosis surgery. The narrow and inconsistent shape of the thoracic pedicles makes the placement of pedicle screws technically challenging. Furthermore, in thoracic curves, the close proximity of the spinal cord and major soft tissue structures also adds a greater risk to the procedure. The esophagus lies close to the upper thoracic vertebras and, an anterior cortical perforation can cause esophageal injury. We report a case of anterior cortical perforation by a T4 pedicle screw complicated by an esophageal perforation in a 15-year-old girl with convulsive encephalopathy. She was operated for a severe neurological scoliosis (Rett syndrome). Her neurological condition deteriorated 3 years after the posterior spinal surgery, requiring a percutaneous gastrostomy. An intra-esophageal screw was discovered incidentally during an endoscopy. We decided not to remove this screw, because the patient's health status presented a surgical contraindication. The patient showed no apparent discomfort at the 10-year follow-up examination after spinal arthrodesis. Esophageal perforation caused by a posterior pedicle screw is very rare. We highlight the risk of injury to esophagus from pedicle screws in upper thoracic vertebra. The systematic removal of a malpositioned screw must be discussed, on a case-to-case benefit-risk basis, especially if the patient has numerous comorbidities, given the long-term tolerance of a number of these improperly positioned implants

Influence of school bag carrying on gait kinetics.

International audienceThe purpose of this study was to determine the effect of different methods of backpack carrying on gait kinetics in children, using a new treadmill that allowed three-dimensional measurement of right and left leg ground reaction forces (GRFs). Forty-one healthy children, with a mean age of 12 years, participated in this study. The mean height was 152 cm and the mean weight 40 kg. The three trials consisted of walking on the treadmill at the speed of 3.5 km/h, first without a backpack and then carrying a 10 kg school bag on the right shoulder or on both shoulders. For each carrying condition GRFs were recorded, averaged, and analyzed for 30 steps. Stride, stance, double stance, thirteen specific GRF parameters and the symmetry index were measured. The right leg produced higher propulsive fore-aft forces than the left one, whatever the walking conditions. For the two maximum peaks and the average vertical force during stance, a statistical difference was found between walking without a backpack and carrying a backpack on one or two shoulders (one or two shoulder carrying > no backpack) but never between one-shoulder and two-shoulder carrying. The children increased their stance and double stance when walking with a backpack compared with walking without a pack. The symmetry index increased with one-strap carrying (compared with no backpack and two-strap carrying) for the maximum force during the breaking phase (Fy1) when it decreased for the maximum propulsive horizontal force before taking-off (Fy2). Children should be advised to carry their backpack on two shoulders rather than use a one-strap backpack

Mosaicplasty for femoral osteochondritis dissecans

International audienceThe authors describe a surgical mosaicplasty technique, with an anterior surgical dislocation approach without trochanterotomy, for osteochondritis dissecans of the hip. A graft was taken from the lateral condyle of the knee. Two adolescents underwent this procedure with good results. No osteonecrosis was observed at the longest follow-up. Mosaicplasty is a useful treatment method for small osteochondritis dissecans (<2cm(2))

Apports de l'hippothérapie dans la prise en charge du handicap

ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Arrachements des épines iliaques antéro-supérieures et antéro-inférieures chez l'enfant et l'adolescent sportifs (à propos de dix cas)

Les arrachements des épines iliaques antérieures chez l'adolescent et l'enfant sportifs sont des accidents aigus rares. Tous les enfants ont été traités de façon orthopédique avec repos strict, anti-inflammatoires non stéroïdiens et dispense de sport de trois mois. Aucune séquelle ultérieure n'a été signalée tous les patients ayant repris une activité sportive identique à celle pratiquée avant l'accident. Il semble que le traitement orthopédique chez les adolescents et enfants victimes d'avulsions des apophyses iliaques antérieures, supérieures ou inférieures, soit suffisant et n'entraîne aucune séquelle ultérieure.ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

Influence of speed variation and age on the asymmetry of ground reaction forces and stride parameters of normal gait in children

International audienceThe purpose of this study was to assess the influence of age and speed on the asymmetry of ground reaction forces (GRFs) and spatiotemporal parameters (STPs) during normal gait in 4- to 10-year-old children. Forty-seven children walked at three speeds on a treadmill dynamometer (ADAL; Tecmachine, Andrézieux Bouthéon, France). Thirty steps were recorded at each speed for each foot for each child. The GRF and stride parameters were normalized to body weight and to body height, respectively. A left-right symmetry index (SI) was calculated for each parameter. The influence of both age and speed on the different SI was examined with a two-way analysis of variance. GRF and STP were asymmetric (SI ranged from +/- 1.92% to +/- 45.05%). The SI of forces Fz1 and Fy1 are negative in children aged 4-6 years, indicating that left Fz1 and Fy1 are higher than right Fz1 and Fy1. The cross effect of age and speed on the asymmetries of gait parameters was not significant There was no significant effect of age on the asymmetries of vertical GRF and STP. The asymmetry of vertical propulsive force (Fz3) alone increased with the speed (P < 0.05). This study showed that the different tasks performed by the lower limbs could be responsible for the asymmetry of GRF and STP in children aged 4-6 years. It also shows that upper and lower limits of normal asymmetry of gait parameters are different. Therefore no single criterion value can be used to assess the symmetry of several gait parameters. The small values of upper and lower limits of symmetry indices of vertical forces and stride duration show that the symmetry indices of these variables are reliable measurements and should thus be used in symmetry analysis of gait in normal and disabled children

Influence de l'âge et de la vitesse sur les paramètres de la marche de l'enfant sain

Objectifs: Evaluer l'effet de l'âge et de la vitesse sur la symétrie et la variabilité des forces de réaction (GRF) et des paramètres temporels de la marche de l'enfant sain. Méthode : 47 enfants sains âgés de 4 à 10 ans ont été réparties en trois groupes d'âge. Chaque enfant a marché à trois vitesses constantes sur un tapis roulant (ADAL). Résultats : Les effets de l'âge et de la vitesse sont significatifs sur les valeurs et la variabilité intra sujet des paramètres. L'influence de l'âge est significative sur l'asymétrie des GRF antéro postérieures. Seule l'asymétrie de la force de propulsion verticale augmente avec la vitesse. Discussion : Aucune différence significative n'existe entre les enfants de 6-8 ans et ceux de 8-10 ans. Il semble que l'effet de l'âge persiste jusqu'à 8 ans. Pour la plupart des paramètres, l'influence de la vitesse n'est pas significative quand celle-ci varie de 3.6 à 4.5 km/h.ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF